The Inner Work of Physician-Patient Relationship…And Other Things

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Tag Archives: Abraham Maslow

Friends, don’t you just love when an idea you resonate with recurs in your consciousness from disparate sources in short order, further deepening its meaning? I share three pieces with you this week, which all deepened my commitment to embracing the paradox of attunement and differentiation.

First, I listened again to Brené Brown’s Braving theWilderness. I highly recommend this book to help us all, conservatives and progressives alike, engage (not avoid) one another this election year with a lot more compassion, civility, and mutual respect. Throughout the book Sister Brené shares personal stories as well as evidence from her research that define true belonging, which I think of as another expression for self-actualization and self-transcendence. In her words:

True belonging requires us to believe in and belong to ourselves so fully that we can find sacredness in both being a part of something, and standing alone when necessary. But in a culture that’s rife with perfectionism and pleasing, and with the erosion of civility, it’s easy to stay quiet, hide in our ideological bunkers, or fit in rather than show up as our true selves and brave the wilderness of uncertainty and criticism.

Attune and differentiate: these two practices are not only not mutually exclusive, they are essential and integral for whole person and societal health and well-being. Read the book to adopt her four practices to advance true belonging, for yourself and for all of us:

People Are Hard to Hate Close Up. Move In.

Speak Truth to Bullshit. Be Civil.

Hold Hands. With Strangers.

Strong Back. Soft Front. Wild Heart.

Second, I met Massimo on Ozan’s last Inner Circle Zoom call. He is a designer and facilitator from Italy—thank you again, Ozan, for connecting so many of us all around the world! Massimo has launched a blog, which resonated with me because he also advocates finding your voice (differentiating) as well as finding a community of belonging (attunement) as a reason to write:

…Meet new people and to interact with them

Learning adventures can make you feel on a solitary path, too much unbalanced on the input, reading and digesting side without much interaction. Expand your network, look for more interactive exchanges with whom might provide an alternative, critical point of view compared to yours. Exposing your opinions leads self-selecting people to network and resonate with you. Find your tribe. We need many and none at the same time. You need different communities where to manifest and explore your interests. On the other hand, you need to better focus on creating those which are more fertile ground to nurture your continuously changing interests and aspirations.

Third, I read David Brooks’s article in The New York Times on the ethos of Scandanavian education. Eloquent as usual, he synthesizes a complex set of ideas into language we can all understand:

19th-century Nordic elites…realized that they were going to have to make lifelong learning a part of the natural fabric of society.

…(Their system) is devised to help (students) understand complex systems and see the relations between things — between self and society, between a community of relationships in a family and a town.

…Nordic educators also worked hard to develop the student’s internal awareness. That is to say, they helped students see the forces always roiling inside the self — the emotions, cravings, wounds and desires. If you could see those forces and their interplay, as if from the outside, you could be their master and not their slave.

…Their intuition was that as people grow, they have the ability to go through developmental phases, to see themselves and the world through ever more complex lenses. A young child may blindly obey authority — Mom, Dad, teacher. Then she internalizes and conforms to the norms of the group. Then she learns to create her own norms based on her own values. Then she learns to see herself as a node in a network of selves and thus learns mutuality and holistic thinking. [See Changing on the Job by Jennifer Garvey Berger for more on this theory of adult development.]

Scandanavians…have a distinctive sense of the relationship between personal freedom and communal responsibility.

(Meanwhile, in the United States…) If you have a thin educational system that does not help students see the webs of significance between people, does not even help students see how they see, you’re going to wind up with a society in which people can’t see through each other’s lenses.

In 2020 more than ever, we need to cultivate much stronger relationship skills. We must identify and honor our core values and stand up for them, even when attacked by those closest to us—perhaps even especially then. How we honor our best selves determines how we honor others. When we show up at our most honest and authentic, we can call forth the same in others to meet us. We can relate as fellow humans, inextricably connected, mutually interdependent, and all in it together. Once we realize this, we can know in our hearts that we truly belong to ourselves and to one another, and we can more easily get on with the world’s most important work—connecting humanity in health, safety, and love.

Hey friends, how was your week? Learn anything new and interesting? Anneal any new ideas to existing frameworks in your already complex world view? I did! And it came in another big wave after my presentation on Friday.

I wrote last week about how I put together a new presentation. For the first time, I added the idea of medicine as a complex adaptive system to a talk I gave to physicians at various levels of training and practice. The objective of the presentation was for people to understand the scope of physician burnout, and leave with some ideas of how they could not only cope better themselves today, but also influence the system and move it toward a healthier, more compassionate state in the future.

As usual for my talks, I focused first on personal resilience. Many physicians push back at this idea, and rightly so, as many medical organizations have instituted physician wellness programs aimed mainly at ‘fixing’ the doctors with yoga and meditation classes, while allowing the system that burns them out to continue its toxic trends toward over-regulation, loss of physician autonomy, and driving metrics that lie outside of, or even counter to, our core values. I worried that my talk would be taken as just another attempt to tell physicians we aren’t good enough at self-care.

Thankfully, the feedback so far has been positive and I have not heard anyone say they felt berated or shamed. I hope it’s because in addition to tips for self-care (eg 7 minute workout, picnic plate method of eating), I talked about how each of us can actually help change the system. In a complex system, each individual (a ‘node’) is connected to each other individual, directly or indirectly. So, difficult as it may be to see in medicine, everything I do affects all others, and everything each other does affects me. This means I can be a victim and an agent at the same time, and the more I choose one or the other (when I am able to choose), I actively, if unintentionally, contribute to the self-organizing system moving in one direction or another [URL credit for image below pending].

My primary objective in every presentation is to inspire each member of my audience to claim their agency. Before that can happen we must recognize that we have any agency to begin with, then shore up our resources to exercise it (self-care and relationships), and then decide where, when, and how that agency is best directed.

In 5 years of PowerPoint iterations, including and excluding certain concepts, I have always incorporated David Logan’s framework of stages of tribal culture. Basically there are 5 stages, 1-3 being low functioning, and 4-5 high functioning. The tribal mantras for the first three stages are, respectively, “Live sucks,” “My life sucks,” and “I’m great”. Stage four tribes say, “We’re great” and in stage 5 we say, “Life’s great.” The gap between stages 3 and 4 is wide, as evidenced by the traffic jam of people and tribes at the third stage. In my view, the difference is mindset. In the first three stages, most individuals’ implicit focus is on self, and subconscious mindset centers around scarcity and competition. Victims abound in these cultures, as we focus on recognition, advancement, and getting ours. We cross the chasm when we are able to step back and recognize how our mutual connections and how we cultivate them make us better—together—we see the network surrounding and tied to our lone-node-selves.

This week I realized that crossing the stage 3-to-4 chasm relates to two frameworks I learned recently:

The way I see it, in Logan’s tribal culture structure, one initially works toward self-actualization, essentially achieving it when fully inhabiting stage 3, “I’m great.” But crossing to stage 4 requires self-transcendence, as described by Abraham Maslow, by recognizing a greater purpose for one’s existence than simply advancing self-interest. In the same way, through stage 3 we live in what the Arbinger Institute describes as an ‘inward mindset,’ and we cross to stage 4 when we acquire an ‘outward mindset’, which is pretty much what it sounds like. Essentially in stage 3 we mostly say, “I’m great, and I’m surrounded by idiots,” and in stages 4 and 5 the prevailing sentiment resembles, “We’re great, life’s great, and I’m so happy to be here, grateful for the opportunity to contribute.”

An astute colleague pointed out during my talk on Friday that we do not live strictly in one stage or mindset in serial fashion. Depending on circumstances, context, and yes, state of mind and body (hence the importance of self-care!), we move freely and maybe often between stages, sometimes in the very same conversation! The goals are to 1) look for role models to lead us to higher functioning stages more of the time, and 2) model for others around us to climb the tribal culture mountain with us, spending more and more mindset and energy at higher and higher stages.

The problem is the system, and we are the system. So, onward. Progress moves slowly and inevitably. It will take time, energy, and collective effort.